Gastroenterology
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Comparative Study
Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label.
Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity. ⋯ Extraintestinal manifestations (joints) and complications (cholecystitis) were also identified correctly by the 99mTc scan. The study demonstrates that leukocyte scanning with technetium 99m-hexamethyl propylene amine oxine as a label can reliably assess the location and, to a lesser degree, activity of Crohn's disease. This technique is more convenient and provides images far superior to those produced by indium 111-labeled leukocyte scanning.
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Upper esophageal sphincter function was investigated during swallows of graded volumes in 8 normal volunteers. Concurrent recordings of video-fluoroscopic and manometric studies were obtained and correlated with each other by means of a videotimer. Maximal upper esophageal sphincter (UES) pressure was typically located 1.5 cm distal to the air-tissue interface between the hypopharynx and the proximal margin of the sphincter. ⋯ Thus, the dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus. Larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of sphincter relaxation. Analysis of the timing of other reference points within the pharyngeal swallow sequence indicated that as the manometric interval of UES relaxation increased, the period of laryngeal elevation was prolonged, the UES relaxed earlier and contracted later, and the interval between the onset of laryngeal elevation and hypopharyngeal contraction increased.
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Letter Comparative Study
Screening for colorectal cancer in a high risk population.
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This study examines the effects of nonsteroidal antiinflammatory drugs on the small intestine in humans. Using an 111In-leukocyte technique in patients with rheumatoid arthritis (n = 90) and osteoarthritis (n = 7), it appears that nonsteroidal antiinflammatory drugs cause small intestinal inflammation in two-thirds of patients on long-term treatment and on discontinuation, the inflammation may persist for up to 16 mo. The prevalence and magnitude of the intestinal inflammation was unrelated to the type and dose of nonsteroidal drugs and previous or concomitant second-line drug treatment. ⋯ Eighteen patients on nonsteroidal antiinflammatory drugs underwent a radiologic examination of the small bowel and 3 were found to have asymptomatic ileal disease with ulceration and strictures. Nineteen patients on nonsteroidal antiinflammatory drugs, 20 healthy controls, and 13 patients with Crohn's ileitis underwent a dual radioisotopic ileal function test with tauro 23 (75Se) selena-25-homocholic acid and cobalt 58-labeled cyanocobalamine. On day 4, more than half of the patients with rheumatoid arthritis had evidence of bile acid malabsorption, but the ileal dysfunction was much milder than seen in patients with Crohn's ileitis.
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Comparative Study
Comparison of an intravenous selective mesenteric vasodilator with intraarterial papaverine in experimental nonocclusive mesenteric ischemia.
Acute nonocclusive mesenteric ischemia was produced in dogs anesthetized with pentobarbital by reversible pericardial tamponade, which reduced cardiac output and mesenteric blood flow by approximately 42% and 53%, respectively. Papaverine, infused into the cephalic (superior) mesenteric artery at an average dose of 100 micrograms/kg X min, was completely effective in restoring mesenteric blood flow and correcting altered intestinal oxygen kinetics. However, the same dose of papaverine given intravenously to other dogs was ineffective in correcting the deranged hemodynamics and oxygen kinetics. ⋯ In comparison, synthetic urotensin I, a highly selective mesenteric vasodilator peptide, produced results identical to those produced by intraarterial papaverine, even though it was given intravenously in small doses (average dose: 13 ng/kg . min). Moreover, it produced no systemic effects. These results suggest that intravenous urotensin I is as effective as intraarterial papaverine in a model of severe mesenteric ischemia, and that it should be examined for a possible clinical role in the treatment of acute mesenteric ischemia in humans.